• Tuberculosis and Respiratory Diseases
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• v.81 no.1
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• pp.19-28
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• 2018

Cancer is the leading cause of death in the Republic of Korea and cancer death accounts for 27.8% of the total deaths, which is not only a social issue but also a concern for the public. Among the cancer death rates, lung cancer mortality account for 34 deaths per 100,000 populations, making it the number one cancer death rate. In a preliminary report on cancer death in 2012, the lung cancer mortality ratio showed the regional variation indicating that there were differences in the qualitative level and the structure among the medical care benefit agency and in the assessment of the treatment process. Therefore, the Health Insurance Review and Assessment Service (HIRA) had begun evaluation of the assessment of lung cancer treatment since 2014 to improve the quality of lung cancer care through evaluation and feeds back the results of lung cancer care process. In this report, authors described the current Indicators for the lung cancer adequacy assessment proposed by HIRA and results of the evaluation reported in 2017.

• Korean Journal of Community Nutrition
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• v.20 no.3
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• pp.220-235
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• 2015

Objectives: The purpose of this study was to investigate how clinical nutrition services is provided at a long term care hospital in Korea and to investigate job satisfaction levels of the clinical dietitians. Methods: Survey questionnaire was sent to dietitians working at a long term care hospital in Korea. The participating hospitals (n=240) were randomly selected from 1,180 long- term care hospitals using a stratified sampling method. A total of 134 long term care hospital s and 223 dietitians completed the survey of clinical nutrition service s and job satisfaction questionnaires The job satisfaction questionnaire included 27 job satisfaction questions on task, stability vision, working conditions, and relationship areas. Results: The average nutritional screening rate was 17.9% and the rate of computerized nutritional screening system was 9.7% in the participating hospitals. Nutritional intervention rate was only 3.2% of all patients. KOIHA (Korea Institute for Healthcare Accreditation) accreditated hospitals showed only 50% performance rate of nutrition service evaluation area. This shows that after achieving KOIHA accredition, many hospitals do not emphasize the performance of nutritional services. The job satisfaction scores in all four areas ranged from 2/5 to 3/5, implying generally low job satisfaction level in hospital dietitians. Linear regression analysis results showed that the "hospital adequacy grade" type was a significant predictor of job satisfaction level for two areas (working conditions & relationship). Conclusions: There is a need to provide proper standardized clinical nutrition services as a primary treatment and we observed large variations in the quality of nutritional service s in long term care hospitals. Therefore, government and local hospitals have to work on implementing nutritional programs and policies for improved service and care.

• Radiation Oncology Journal
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• v.21 no.3
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• pp.183-191
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• 2003

Purpose: To suggest the optimal radiation fields after a surgical resection based on a nationwide survey on the principles of radiotherapy for rectal cancer in the Korean Patterns on Care Study. Materials and method: A consensus committee, composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area, developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer after a surgical resection. The survey format included 19 questions on the principles of defining field margins, and was sent to the radiation oncologists in charge of gastrointestinal malignancies in all korean hospitals (48 hospitals). Thirty three ($69\%$) oncologists replied. On the basis of the replies and literature review, the committee developed guidelines for the optimal radiation fields nor rectal cancer Results: The following guidelines were developed: superior border between the lower tip on the L5 vertebral body and upper sacroiliac joint; inferior border $2\~3$ cm distal to the anastomosis in patient whose sphincter was saved, and $2\~3$ cm distal to the perineal scar In patients whose anal sphincter was sacrificed; anterior margin at the posterior lip of the symphysis pubis or $2\~3$ cm anterior to the vertebral body, to include the internal iliac lymph node and posterior margin $1.5\~2$ cm posterior to the anterior surface of the surface, to include the presacral space with enough margin. Comparison with the guidelines, the replies on the superior margin coincided in 23 cases ($70\%$), the inferior margin after sphincter saving surgery in 13 ($39\%$), the inferior margin after adbominoperineal resection in 32 ($97\%$), the lateral margin in 32 ($97\%$), the posterior margins in 32 ($97\%$) and the anterior margin in 16 ($45\%$). Conclusion: These recommendations should be tailored to each patient according to the clinical characteristics such as tumor location, pathological and operative findings, for the optimal treatment. The adequacy of these guidelines should be proved be following the Korean Patterns of Care Study.

• The Korean Journal of Health Service Management
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• v.2 no.1
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• pp.137-154
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• 2008

The increase of the supply of medical service and the increase of hospitals have intensified the competition of hospitals, and the advancement towards internationalization in the opening of medical industry has triggered the infinite competition of medical profession. In addition, the high expectation of customers and quality improvement in the medical care in accordance with the improvement of overall income, and the change of active role of medical consumers according to the popularization and the improvement of rights awareness reflect the customer needs and choice in the medical service. Customers wanted to receive the kind and pleasant service under the up-to-date medical service. Therefore, as a solution, hospital coordinators were emerged for the purpose of smooth treatment and customer satisfaction by generalizing all service of hospital. Accordingly, this thesis attempted to investigate the effect of hospital coordinator education curriculum on the education satisfaction and the quality of medical service. In order to solve the purpose of this study, I, author reviewed the existing literatures, established hypothesis, and verified hypothesis by using the variety of statistics techniques such as reliability, validity, frequency analysis, and regression analysis. The verification of hypothesis is as followings: First, among education training factors of hospital coordinators, the quality of instructor significantly affects the satisfaction of hospital coordinator education training. Second, among training factors of hospital coordinator, the attitude of trainee significantly affects the training satisfaction of hospital coordinator. Third, among education training factors of hospital coordinator, education course significantly affects the training satisfaction of hospital coordinator education. As the qualities of instructor are better equipped, the satisfaction of education becomes higher. It indicates that the education method of instructors is important as an index to represent the qualities of instructor such as the appropriateness of education method, preparation, passion, visual materials, the adequacy of education procession, and specialized knowledge, and it has important effect on the satisfaction of education. In order to enhance the satisfaction of hospital coordinator education, the creation of education environment, making trainee concentrate on the education, is required by appropriately allocating programs, arousing interest in education, based on the attitude of trainee, discussion, and preliminary programs, preparation, ahead of enforcement of education. Fourth, the satisfaction of hospital coordinator education training significantly affects the reliability among the qualities of medical service. Fifth, satisfaction of hospital coordinator education training significantly affects hospitality I kindness among the qualities of medical service. If the education satisfaction of trainee is high, it is effective in the practical application such as dealing with complaints, the duty performance for the patients, and so on in offering the medical service, related to reliability and furthermore, we can find the positive change in the attitude change of medical professions related to the reliability of hospital coordinator. In addition, in the process of offering medical services such as the kind explanation on the duty, rapid response to the customers inquiry, and tidy uniform, practical effect was verified. Sixth, the education training factor of hospital coordinator significantly affects the reliability among the quality of medical service. Seventh, the education training factors of hospital coordinator significantly affect hospitality/kindness. In the education of hospital coordinator, the methods to attract the interest of trainee by emphasizing reliability should be sought and for gaining the practical effect of hospital coordinator education, the sufficient preparation and investigation on the education curriculum should be prerequisite and under this condition, intensified discussion on the instructor and education course is needed. In the design of education course, more education hours and subjects should be allocated in the part of hospitality in order to improve the practical application of hospitality. Therefore, it is meaningful in a sense that this study newly approached the components of hospital coordinator education and the need to modify the quality components of medical service in accordance with the study subjects was raised. This study also finds its meaning in that it provides basic materials for the study of future hospital coordinator education by suggesting the system development model of hospital coordinator education through preliminary study of education training. In addition, this study is meaningful in the aspect that it suggested the direction of education training by showing how the hospital coordinator education training would applied to the hospital coordinator course of the Continuing Education Center at Pusan and Kyungnam National University to some extent. Since all investigation of this study was approached from the side of hospital coordinator, the thoughts of patients who are beneficiaries of medical service, and care givers cannot be identified. Therefore, the satisfaction of patients and care givers through the experience of medical service, which is the essential prerequisite of medical service, should be importantly considered and investigated. Accordingly, The study of comparing and analyzing the views of both patients and care givers should be carried out in the future.

• Korean Journal of Clinical Pharmacy
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• v.28 no.3
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• pp.224-229
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• 2018

Background: The patients receiving hematopoietic stem cell transplantation (HSCT) are known to have a high incidence of breakthrough nausea and vomiting due to the conditioning regimen. The purpose of this study was to evaluate the adequacy of antiemetic therapy for breakthrough nausea and vomiting in patients receiving HSCT and to propose an effective treatment regimen. Methods: We retrospectively reviewed the electronic medical records of 109 adult patients. The collected data were used to identify (1) antiemetic and dosing regimens prescribed for controlling breakthrough nausea and vomiting, (2) the rate of patients who developed breakthrough nausea and vomiting, and (3) the percent of antiemetics prescribed on the day of symptom onset. Based on the National Comprehensive Cancer Network guideline, we assessed the suitability of antiemetics for breakthrough nausea and vomiting, and prescription timing. Results: All patients were prescribed pro re nata antiemetics. About 40.0%, 41.4%, and 18.6% of patients were using one, two, and three or more additional drugs for breakthrough nausea and vomiting, respectively. The most frequently administered drugs were intravenous metoclopramide (43.8%) and granisetron patch (36.2%). Breakthrough nausea and vomiting occurred in 87 patients (79.1%) and they developed symptoms 320 cases. About 220 cases (68.8%) were treated with additional antiemetics on the day of symptom onset and the rate of symptom resolution was only 10.3% (9 patients). Conclusion: The breakthrough nausea and vomiting in patients receiving HSCT occurred very frequently and was hard to control, thus requiring more rapid and aggressive treatments.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.12
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• pp.4935-4944
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• 2010

The purpose of this study was to investigate the perceived difficulties during both pre-treatment period and admission period for radioactive iodine therapy (RAIT), the level of information about RAIT provided by medical staffs and the satisfaction of RAIT process in thyroid cancer patients receiving RAIT. Participants were 165 thyroid cancer patients, who had total thyroidectomy and had been offered RAIT. The data were collected using structured questionnaire and open-ended questions and analyzed by descriptive statistics and content analysis. The most frequent perceived difficulties of RAIT was associated with thyroid specific symptoms during both pre-RAIT period and RAIT admission period(38.2% vs 43.0%). The rating of RAIT information provided by medical staffs was evaluated as over moderate level(mean $3.63{\pm}0.80$). The RAIT process satisfaction was investigated as moderate level(mean $6.43{\pm}2.21$). the satisfaction of RAIT was the highest in medical attention and coping procedure (mean $7.64{\pm}2.37$) however it was the lowest in adequacy of RAIT information(mean $5.67{\pm}2.78$). Thus the nursing intervention program for thyroid cancer patient undergoing RAIT should be developed to support needs of thyroid cancer patients related to thyroid specific symptoms and to improve patients' understanding about RAIT procedure so that patients have competence to participate in therapeutic activities efficiently.

• Journal of the Korea Institute of Information and Communication Engineering
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• v.9 no.5
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• pp.1045-1051
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• 2005

We developed an orofacial pains diagnosis/therapy system which can enlarge a therapy effect through a new stimulation. Contrary to its established method, this therapy system(DDTS-1) is a treating method which absorbs a surplus ion charge- the cause of an outbreak of a pain-of the human body using a capacitor. Absorbing a surplus ion charge of the human body with effect, it obtained optimal parameters which is control signal to control charging/discharging a capacitor to be 6Hz, and capacitance to be $0.1\~0.33{\mu}F.$ Through clinical demonstration, experimented on among patients-namely dental pain patients, joint disorders patients, and trigeminal neuralgia patients to verification of system. In result, an EAST stimulater had a very low change of abnormal potential against normal potential before/after being placed under medical care. DDTS-1 showed obvious differences that two potentials are one and the same potential or one potential is similar to the other one. DDTS-1 comparing with EAST showed the remedial value of the comparative advantage in all the medical treatment of pains. Therefore, stimulation of DDTS-1 is more effective than the existing electric stimulation. We verified its validity of ion charge absorption in the human body using capacitor which presented the present thesis. That is, we verified theoretical adequacy of control action in a pain, and its efficiency as well as confidence.

• Journal of Korean society of Dental Hygiene
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• v.4 no.2
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• pp.277-291
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• 2004

The purpose of this study is to analyze the dental hygienists' overall performance in operative restoration and the clinical performance in operative restoration according to dental hygienists' career and to provide basic data for establishing the appropriate range of dental hygienists' work. Subjects of this study are 339 dental hygienists working at dental clinic and hospital nationwide, selected by their working place, career, type of clinic, and location of clinical institution. The distribution of people who responded to the survey shows that 81 belong to beginner level(less than 2 years since entering clinic), 115 intermediate level(2 to 3 years since entering clinic), 81 higher level(4 to 5 years since entering clinic) and 62 advanced level(more than 6 years since their entering clinic). In terms of the types of clinical institution, 178 belong to dental clinics and 161 belong to dental hospitals. The survey used in this study are focused on perception about clinical performance in operative dentistry and adequacy of the work. Operative dentistry consists of operative restoration and endodontic therapy. The operative restoration consists of 15 categories such as patient welcoming, examination and diagnosis, planning of treatment, anesthesia, control of moisture, cavity preparation, pulp protection, matrix band application, amalgam filling, resin filling, glass ionomer cement filling, abrasive strip removal, rubber dam removal, bite check and polishing, patient education, and arrangement. The reliability was Cronbach's Alpha .9453. SPSS 10.0 for Windows was used to analyze the responses. One way ANOVA was utilized to verify the differences in the dental hygienists' job performance in operative restoration and their job performance according to career. When significant difference was found. Duncan multi comparison post hoc was done. To sum up the results of this study, patient welcoming look the first place in the operative restoration. It was followed by patient education, examination and diagnosis, introducing treatment plan, resin filling, glass ionomer cement filling, amalgam filling, bite check and polishing, anesthesia, pulp protection, control of moisture, abrasive strip removal, cavity preparation, matrix band application, rubber dam removal, and anesthesia. In terms of the clinical performance by career, there were significant differences in 19 activities such as medical eraluation, oral examination, patient charting, intra oral readio graphs, firm developing fixing mounting, curing light gun, education of attention content after operation. Based on the results of this study, the specific range of operative restoration for dental hygienists should be focused on providing basic data for dentists' diagnosis, alleviation of fear and aching accompanied by injection and anesthesia, data providing for dentists' decision of anesthesia degree, and maximization of control of moisture.

• Radiation Oncology Journal
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• v.16 no.3
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• pp.265-274
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• 1998

Purpose : This prospective study has been conducted to assess the value of three dimensional conformal radiation therapy (3DCRT) for lung cancer and to determine its potential advantage over current treatment approaches. Specific aims of this study were to 1) find the most ideal 3DCRT technique 2) establish the maximum tolerance dose that can be delivered with 3DCRT and 3) identify patients at risk for development of radiation pneumonitis. Materials and Methods : Beginning in Nov. 1994, 95 patients with inoperable non-small cell lung cancer (stage I; 4, stage II; 1, stage IIIa; 14, stage IIIb; 76) were entered onto this 3D conformal trial Areas of known disease and elective nodal areas were initially treated to 45 Gy and then using 3DCRT technique 65 to 70 Gy of total dose were delivered to the gross disease. Sixty nine patients received 65 Gy of total dose and 26 received 70 Gy Seventy eight patients (82.1$\%$) also received concurrent MVP chemotherapy. 3DCRT plans were compared with 2D plans to assess the adequacy of dose delivery to target volume, dose volume histograms for normal tissue, and normal tissue complication Probabilities (NTCP). Results : Most of plans (78/95) were composed of non-coplanar multiple (4-8) fields. Coplanar segmented conformal therapy was used in 17 pateints, choosing the proper gantry angle which minimize normal lung exposure in each segment. 3DCRT gave the full dose to nearly 100$\%$ of the gross disease target volume in all patients. The mean NTCP for ipsilateral lung with 3DCRT (range; 0.17-0.43) was 68$\%$ of the mean NTCP with 2D treatment planning (range; 0.27-0.66). DVH analysis for heart showed that irradiated volume of heart could be significantly reduced by non-coplanar 3D approach especially in the case of left lower lobe lesion. Of 95 patients evaluable for response, 75 (79$\%$), showed major response including 25 (26$\%$) with complete responses and 50 (53$\%$) with partial responses. One and two rear overall survivals of stage III patients were 62.6$\%$ and 35.2$\%$ respectively. Twenty percent (19/95) of patients had pneumonitis; Eight patients had grade 1 pneumonitis and 11 other patients had grade 2. Comparison of the average of NTCP for lung showed a significant difference between patients with and without radiation pneumonitis. Average NTCP for Patients without complication was 62$\%$ of those with complications. Conclusions : This study showed that non-coplanar multiple fields (4-8) may be one of the ideal plans for 3DCRT for lung cancer. It also suggested that 3DCRT may provide superior delivery of high dose radiation with reduced risk to normal tissue and that NTCP can be used as a guideline for the dose escalation.

• The Korean Journal of Rehabilitation Nursing
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• v.3 no.1
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• pp.43-58
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• 2000

Pain management is a major issue in caring of cancer patients. Patients' concerns for reporting pain and taking analgesics are patient-related barriers to the management of cancer pain. Since such study has not been done at all in Korea, it is clearly needed to study on these problems. The purpose of this study is to attain basic data in order to improve cancer pain management in Korea. This is done by: 1) examining the extent of patients' concerns that might be barriers to the optimal pain management, and the extent of related factors (pain management hesitancy, adequacy of using analgesics, pain severity and pain interference); 2) identifying the relationship between patients' concerns and the related factors. The data has been collected from 180 cancer patients who were hospitalized in medical wards of one university hospital in Seoul, Korea during the period from November 1, 1997 to February 28, 1998. The data has been collected through interviews with (1) Barriers Questionnaire - Korean Version (BQ-K); (2) Hesitancy Experience Questionnaires (HQ); (3) Pain Management Index (PMI); (4) Brief Pain Inventory (BPI); and (5) Demographic Data. The data were analyzed by descriptive statistics and by t-test, One-way ANOVA, Pearson correlation using SPSSWIN program. The Results are as following: 1) The mean scores of Pain Management Concerns (PMC) by BQ-K were toward the moderate with a little high points(2.59). Most of the patients (99.4%) had some extent of concerns (over lout of maximum 5 points). Among the eight subscales of BQ-K, the Pain Management Concerns (PMC) about 'Fear of tolerance' was the highest (3.80) and 'Worry about side effects' was the least (1.40). 2) The extent of Pain Management Hesitancy (PMH) by HQ of wnom had pain on the day of the interview was a little higher than moderate score(5.53 out of maximum 10 points). 6.7% of the patients with experiencing pain used less adequate analgesics for the severity of pain than they were expected. 27.8% of them never used any analgesics at all. The mean score of pain severity by BPI was 16.59 (maximum: 40), and that of the interference with daily life by BPI was 32.03 (maximum: 70). 3) The patients who were older, less educated, and in low socio-economic status were likely to have more concerns. Pain Management Concerns (PMC) was positively correlated with Pain Management Hesitancy (PMH) (r=.75), pain severity (r=.44) and pain interference (r=.50). Those who were not using adequate analgesics had higher Pain Management Concerns (PMC) than did those who were using adequate analgesics (t=-5.42). The patients who had more Pain Management Concerns (PMC) tended to hesitate more to report pain and to use analgesics. They used more inadequate analgesics for the severity of pain and also had experienced more pain severity and interference with daily life. In conclusion, the patients' concerns for reporting pain and for using analgesics are major patient-related barriers to cancer pain management in Korea. The patients' concerns were correlated significantly with the level of the hesitancy experience, inadequate use of analgesics, the pain severity and the interference with daily life. Considering this, an educational program for cancer patients under the treatment with analgesics should be developed in order to solve these problems.